CROI 2019 Abstract eBook

Abstract eBook

Poster Abstracts

the time from first experience of HIV-associated vulnerabilities to initial programme contact among young women engaged in sex work (YSW). Methods: We conducted a cross-sectional bio-behavioral survey of 408 cis- female YSW (14-24 years of age) in Mombasa, Kenya in 2015, after geographical mapping and enumeration which estimated a total of 6,127 [range, 4,793 to 7,642] YSW in Mombasa. Timing of HIV-associated vulnerabilities (self- identifying as sex workers; sex in exchange for gifts/money; and physical or sexual violence) and timing of initial contact with a programme were determined by survey questions on “howmany months ago” these events occurred in relation to the survey date. We conducted survival analyses to estimate the rate of initial programme contact since experiencing each HIV- associated vulnerability. We quantified access delay in the survey sample by calculating the person-years between self-identifying as a sex worker and initial programme contact, and then estimated the person-years of delay in total population of YSW in Mombasa. Results: Among 408 YSW, 26% reported any programme contact. The median time to initial programme contact were 18 months [IQR: 8-36] and 24 months[12-36] respectively, from self-identifying as a sex worker, and from first sex in exchange for gifts/money. A total of 38% (N=154) experienced physical or sexual violence prior to programme contact, with a median of 18 months [4-36] from first experience of violence to initial programme contact. Rates of initial programme contact were 0.64 per 100 person-months (95% CI: 0.47 – 0.80); 0.52 (95% CI: 0.39 – 0.65); and 0.48 (95% CI: 0.28 – 0.69), respectively since self-identifying as a sex worker; since first sex in exchange for gifts/money; and since first experience of violence (Figure). Based on YSW population size in Mombasa, we estimated 9,268 to 14,776 person-years of access delay at the population-level. Conclusion: Using a person-year approach, we identified a large gap in programme access among YSW in Mombasa, and among those who accessed the programme, a substantial delay in access. The findings signal an urgent need for prevention services prioritized or tailored to YSW.

1 CDC Uganda, Kampala, Uganda, 2 Uganda Prisons Service, Kampala, Uganda, 3 Makerere University College of Health Sciences, Kampala, Uganda, 4 Uganda Virus Research Institute, Entebbe, Uganda, 5 Uganda Prison Service, Kampala, Uganda Background: Prisoners are one of five WHO-defined key populations disproportionately affected by HIV. Yet, data on prisoners from sub-Saharan Africa, the region with highest HIV burden, are sparse. The Uganda Prisons Service sero-behavioral survey 2013-14 assessed the prevalence of HIV, associated behaviors and infections including Hepatitis B (HBV), Herpes Simplex Virus type 2 (HSV2) and syphilis, among prisoners and staff of Uganda Prisons Service. Methods: We randomly selected 117/241 prison units in a two-stage cluster sampling process with probability proportional to population size. At selected facilities, participants were randomly selected from lists of current prisoners and staff. Prisoners and staff aged ≥ 18 years who provided informed consent were included. A structured questionnaire was administered in English and six local languages, using computer-assisted technologies. Blood was collected for HIV rapid testing (national algorithm), HBV (Murex anti-HBcAb 3rd gen EIA), HSV2 (Kalon ELISA) and syphilis (rapid Taytec with Plasmatec or Human Diagnostics RPR confirmation). Participants with positive test results were referred for management. Statistical analysis factored in design effect but did not include weighting. The study was approved by Ugandan and U.S. Institutional Review Boards. Results: Responding prisoners (n=8919) were 93.6%male with median age 31.1 years. Responding staff (n= 1687) were 63.2%male and had median age 38.1 years. HIV prevalence was 15% for prisoners (15%; 14.4%male; 24.4% female) and 12% for staff (10.5%male; 14.5% female) for staff. For prisoners and staff respectively, HBV prevalence rates were 55.7% and 38.6%, for HSV2 were 44.3% and 50%, and for syphilis were 4.2% and 1.2%.. Injection of illicit drugs was acknowledged by 2.9% and 1.1% of prisoners and staff, and among men, 6.5% of prisoners and 2.9% of staff reported sex with other men. Conclusion: Prisoners and prison staff had double or higher the national adult prevalence of HIV (6.2%), excess burden of related infections, and higher rates of illicit drug use and MSM behavior than national estimates. Over 100,000 individuals cycle through the prison system annually in Uganda. Providing systematic HIV prevention, testing, treatment and related services tailored to the challenges of prison settings is critical to reducing new infections in prisons and communities in Uganda and other countries.

Poster Abstracts

840 QUANTIFYING DELAY IN HIV PROGRAMME ACCESS AMONG YOUNG FEMALE SEX WORKERS IN KENYA Huiting Ma 1 , Marissa Becker 2 , Parinita Bhattacharjee 3 , Helgar Musyoki 4 , Peter B. Gichangi 5 , Robert Lorway 2 , Linwei Wang 1 , Shajy Isac 6 , James F. Blanchard 2 , Sharmistha Mishra 7 1 St. Michael’s Hospital, Toronto, ON, Canada, 2 University of Manitoba, Winnipeg, MB, Canada, 3 Partners For Health and Development, Nairobi, Kenya, 4 National AIDS and STD Control Programme, Nairobi, Kenya, 5 International Centre for Reproductive Health, Mombasa, Kenya, 6 Karnataka Health Promotion Trust, Bengaluru, India, 7 University of Toronto, Toronto, ON, Canada Background: Programme data in Kenya suggest that 85-90% of all female sex workers have been contacted by HIV prevention programmes. Yet missing from these data is the timing of programme access with respect to sex workers’ sexual life-course – such that access delays remain unmeasured. We estimated

841 LITTLE OR NO OVERLAP OF SEXUAL NETWORKS OF TRANSGENDER WOMEN AND MSM IN LIMA, PERU Jessica E. Long 1 , Hugo Sanchez 2 , Dania Calderon Garcia 2 , Leyla Huerta Castillo 2 , Javier R. Lama 2 , Ann Duerr 3

CROI 2019 327